Concerns about maternity services

But there is a need to wait until all the information is available before a final judgement can be made.

Last Friday a new-born baby died at home after the mother and child were discharged from Wellington Hospital within six hours of the baby being delivered. The decision was apparently made by the parents and their midwife, who was employed independently of the hospital.

The incident comes hot on the heels of Capital and Coast District Health Board's move to free up maternity beds earlier by encouraging midwives to discharge mothers from birthing suites from six hours after giving birth. The policy was designed solely for mothers who had a second or subsequent child, with no complications. A $100 grocery voucher would be provided as an incentive. That part of the deal came in for exceptionally harsh criticsm and not surprisingly Capital and Coast reversed the policy within days of setting it.

The death of the new born at home has again concentrated attention on the hospital's and health board's maternity policies.

The parents of the child have said they were not forced to leave the hospital, but were not encouraged to stay. Neither was it clear that they could stay if they wanted to.

The midwife has said the couple made the decision to go and she thought they knew they could stay longer.

Obviously it needs to be transparent to parents of new-born children what they are entitled to and how to get it. Institutions can sometimes have policies, but if no-one knows about them then what is the point? In a twist of the old justice has to be not only done, but seen to be done — policies not only have to be in place but vigorously practised. Patients shouldn't have to ask, or feel they are pushing, for something they are not really entitled to.

Having just had a young child, parents — and especially mothers — are probably not at their most assertive.

But much of the discussion on what happened at Capital Coast Health should wait until it is known the cause of death of the baby that died. Until this is known, and that could be some time, we don't know if the early discharge had anything to do with the death in some way, or more likely, if staying in hospital longer would have picked up on anything that was wrong with the child.

The world of maternity care has changed much in the last 20 years. Marlborough's own maternity facility has changes planned with the redevelopment of the hospital.

Some of that change in New Zealand's maternity services has been instigated by parents wanting to go home earlier, preferring to look after their child in their own house with the attendant care and advice from professionals.

Clearly in the Wellington case the new-born's mum was not the best candidate for early release as a first time mum who had an episiotomy, had not slept in 30 hours, had little outside support from family and with a baby which was not yet breast feeding properly.

It is obvious New Zealand's maternity service providers and parents are still trying to find the right balance between returning to the comforts of home with a new-born — which can save money for the health system — and providing the right level and length of care and support in a hospital or birth unit.